Case Studies


Transforming clinical capabilities through technology at a national healthcare payer

The client, a national payer with Medicaid and Commercial lines of business, had targets to expand into new Medicaid markets but was beleaguered by operational limitations. The care management and utilization departments’ clinical workflows were heavily manual, as they had to work across seventeen disparate systems. Nurses couldn’t effectively access and update member records when in the member’s home, and several compliance gaps had been identified. The client had purchased HealthEdge®’s  GuidingCare® care management platform and hired a multi-billion-dollar consulting firm to plan and execute the implementation, but after several months the project was at a standstill, with the stakeholders unable to agree on the priorities for implementation.

Due to our track record of successful GuidingCare® implementations and our understanding of the business change approach needed for this platform, Anoteros was hired to replace the first consulting firm and we pivoted the project from a technology implementation to a clinical transformation for the payer. We worked to quickly understand the compliance and operational needs of the clinical teams and used that input to develop a phased implementation roadmap. The first release focused on a Minimal Viable Product (MVP), meeting the essential needs of all clinical teams and enabling the client to retain membership in their current market. Subsequent releases would add automation and efficiency gains, enabling the payer to expand into newer markets. We also mapped dependencies with the client’s other transformation initiatives and the GuidingCare® product roadmap. Instead of telling the stakeholders what they should do, we worked to understand their needs and concerns and used that to inform the roadmap. With all stakeholders now on board, the client – with Anoteros’ help – was able to move forward with implementation.

The transformation consolidated clinical operations from seventeen systems to one, automated key clinical workflows, provided mobile capability for nurses’ home visits, and enabled payer-provider collaboration using portals. As a result, the plan was able to reduce its compliance gaps by 75% and increase staff productivity by 40%. These improvements enabled the payer to secure its current market position and expand into new markets. The client called Anoteros “the key reason for the successful transformation of their clinical operations.”


Developing a three-year IT strategy for a legal services non-profit

Our client is one of US’s largest public defender offices, providing legal representation and advocacy free of cost to people facing charges in criminal, family, and immigration courts. Having almost doubled in size over the past five years, the client’s IT capabilities hadn’t kept up with the new scale of the organization. This had been exacerbated by the sudden shift to remote work due to the coronavirus pandemic. The Executive Director saw the need for transformation across all aspects of IT and wanted to think strategically to ensure the change would serve the organization for years to come. Recognizing that achieving this vision would require additional expertise, she asked Anoteros to lead the development of a three-year strategy for IT.

We assembled a team comprising infrastructure and IT service delivery experts and quickly went to work assessing the current state of IT. Through meeting with IT staff, analyzing the network and systems, and conducting an IT satisfaction survey with leaders across the organization, we were able to identify the areas of issue and opportunity. We guided IT and executive leadership on a series of decisions that established the future principles under which IT would operate, for example, making an intentional decision to use cloud-based vs. on-premise services wherever possible, and deciding to optimize the use of the client’s existing investment in the Microsoft environment. We then applied these principles as we formulated recommendations for the future state. We developed a pragmatic roadmap for transforming the organization’s network, security, and data center infrastructure that prioritized increasing security and resiliency. In parallel, we developed recommendations on organization and role design for the IT department, identified areas for skill development, and outlined opportunities for service management process improvements.

IT and executive leadership were thrilled that they had a clear strategy for IT for the first time ever, with a pragmatic roadmap to implement the changes over the next three years and associated expense forecasts to build into the organization’s budget. The client asked us to continue providing support for implementation, for both specialized infrastructure expertise and ‘virtual CIO’ services to guide solution selection decisions and ensure the implementation remains on track.


Modernizing data warehousing for a healthcare software provider

The client is a major software provider for home and community-based healthcare providers and Medicaid-managed care payers. The client wanted to modernize its data warehouse with the goal of achieving near real-time data availability for reporting and analytics, improved ability to react quickly to source schema changes, and improved scalability through a cloud-based architecture. The client was seeking an end-to-end cloud solution utilizing Amazon Redshift as the data warehouse given its existing investments in Amazon Web Services (AWS) infrastructure.

Due to the high stakes of the solution selection decision, we recommended a thorough proof-of-concept and assembled a team of subject matter experts in data architecture, data engineering, and DevOps. After reviewing the current data model, we conducted an architecture review and identified and costed potential tool options. Our engineers set up a development environment and ran an eight-week proof-of-concept where we tested both historic and continuous replication data loads to the new warehouse, created infrastructure and automation scripts, and built sample dashboards. The exercise demonstrated that the client’s requirements could be best met by a combination of Amazon Web Service tools – RedShift and Data Migration Services – coupled with Talend, an Extract, Transform, and Load (ETL) tool Anoteros helped select and license on behalf of the client after testing several market-leading ETL tools.

With the client’s approval to move forward, we set up the production environment, managed the conversion of historic data loads, set up monitoring, alert, and reconciliation mechanisms, and created both automated scripts and procedural manuals for steady-state management. After the new warehouse was live, we continued to support the client team, running both the old and new data pipelines in parallel for a few weeks to ensure the new solution was performing as expected. During this phase, we also built out more robust dashboards for monitoring and trained stakeholders on how to use them, before ultimately disconnecting the old data warehouse and pipeline.

Anoteros’ approach to this complex data warehouse migration gave the client confidence to make vendor and tool selection decisions knowing it could meet their needs. Ultimately, they were able to meet their goals with the implementation of the new data solution including near-time replication from the source systems to the data warehouse. Throughout the project, we complemented the in-house data team’s understanding of the existing data model with expertise in cloud-based data warehousing and were able to guide and coach them so that when our project ended, they were able to independently operate and maintain the new environment.


Increasing nurses’ time with members and reducing staff turnover at a Medicaid MLTC plan

Our client is a Medicaid Managed Long-Term Care (MLTC) payer in New York with members who are home-bound seniors with long-term care needs. When a new member joins the plan, a nurse visits them at home for an assessment to determine their healthcare needs and develop a care plan. Nurses will visit again periodically for additional assessments to ensure the member’s needs are being met over time.

This is a critical part of the care management clinical workflow, however, the client’s process for scheduling nurses for in-home assessment visits was manual and fragmented. Nurses were frustrated with schedules that took them to different corners of New York City on the same day and did not consider their location, skills, and preferences for assignments. This frustration led to constant turnover in staff and the Assessment team was unable to keep up with the rapid growth of the plan’s membership.

Anoteros was hired as a consulting partner to solve the problem. Our team documented the current state processes, identified the inefficiencies, and produced a comprehensive recommendation to improve the scheduling process. Based on our recommendation, the client selected Salesforce as the technology to automate the scheduling of assessment visits, due to its robust field service management capability. We helped the plan select a Salesforce implementation vendor and led the design of a robust solution. The solution mapped member needs with the skills and location of the nurses and provided automated scheduling capability. The solution also integrated DocuSign with Salesforce for e-signatures, and eliminated the paper forms, mini scanners, and printers that the nurses previously carried to the home visits.

The new system enabled the Assessment unit to increase the number of daily in-home assessments by 40%, ensuring members’ needs were identified in a more timely manner. Nurses now spend most of the day using their clinical talents in visits with members because the time spent traveling between appointments is significantly reduced. In addition, an automated scheduling solution is scalable, so the plan was able to add delegated vendors to perform services in newer markets without any additional investment in technology.


Replacing the finance and accounting system for a public health non-profit

Our client is a public health entity dedicated to improving the lives and health of New York City residents. The client sought assistance with implementing a new cloud-based finance accounting system to meet its needs for greater automation and advanced reporting capabilities. To support this transformational project, Anoteros was asked to provide project management services and financial systems expertise.

We assembled a team comprising a program manager, a finance consultant who was a Certified Public Accountant (CPA) with deep product knowledge, and a post-production support team to assist the client team with transitioning from the legacy system to the new solution. Anoteros provided strategic and tactical guidance for redesigning the chart of accounts and assisted with system configuration, testing, and development of extracts for conversion of historical data.

Anoteros helped the client implement the core modules for the new solution – General Ledger, Accounts Payable, and Account Receivable – on time and on budget. Based on the strength of our performance, Anoteros was selected to lead Phase 2 – implementation of the Procurement and Billing modules as well as to provide additional services to the project in the areas of change management, communications, and training-related services.


Care management data migration for a health plan in the US Midwest

The client, a health plan offering Medicaid plans in the Midwest, had launched the implementation of HealthEdge®’s GuidingCare® platform. Unlike its legacy care management system, GuidingCare® would allow integration with other applications, workflow automation, and importantly, the ability to easily scale and therefore support the health plan’s goal of expanding into new markets. Unfortunately, the legacy system vendor was not willing to participate in this transition and instead opted to provide raw data extracts of the client’s clinical records without documentation on the data model.

Anoteros was hired to migrate the data from the legacy system to GuidingCare®. We tapped into our deep healthcare payer experience, knowledge of care management, and expertise in data and technology. We brought together a team of data and business analysts, developers, and a project manager. The team hit the ground running, quickly learned the data model of the legacy system, and developed a data migration and archival strategy. The strategy not only included the steps to migrate data into GuidingCare® but also included steps to address the front-end and workflow impacts once the data was migrated into GuidingCare®. Our team created the data mapping specifications, developed the data migration routines, performed system testing, and facilitated the user acceptance testing of the migrated data in GuidingCare®.

The data migration was successful and supported a seamless transition between care management platforms for the end-users. The data archival strategy positioned the health plan to easily respond to future audits. Overall, the data migration allowed the client to complete the implementation project and turn their focus to expansion efforts.


Modernizing case and document management systems for a legal services non-profit

Our client is one of the US’s largest public defender offices, providing legal representation and advocacy free of cost to people facing charges in criminal, family, and immigration courts. When the Executive Director engaged us, each of their practice areas was using different case and document management systems to manage the workflow and client records for their cases. The capabilities of each system varied, and some of the platforms were outdated and not able to meet the client’s current security and resiliency standards. The siloed systems made it difficult to handle cases that involved multiple practice areas, and there was significant manual effort involved in analyzing case data and preparing reports that our client’s funders required, as well as additional IT burden to manage multiple systems and vendors. The client had already begun researching options for a new, unified, case management system and the Executive Director engaged Anoteros to bring expertise in technology sourcing and to accelerate the process.

We mobilized an Anoteros team to drive the selection process forward. Our business analysis experts held workshops with each practice area to understand their day-to-day working processes and then document detailed functional requirements for the new systems. In parallel, we began reviewing the functional capabilities of the potential vendor systems, as well as using Anoteros’ IT expertise to define service level, system, and security requirements. Once the requirements were defined, we issued a detailed Request for Proposal and then held a series of scripted demos where representatives from each of the practice areas were able to review each product’s suitability for their own unique workflows. The client selected a case management system that was designed specifically for legal case management but built on a Salesforce platform, providing significant capability to customize workflows across the legal practices. We also assisted the client with selecting a document management system that could easily integrate with the chosen case management system. We developed a high-level implementation plan and led contract negotiations with the vendors.

Anoteros enabled the client to conduct a rapid business analysis and selection process, reaching a selection decision within just 12 weeks. Our team complimented the client’s legal practice expertise with application, security, and sourcing expertise, together allowing for a comprehensive and diligent selection process. Anoteros is thrilled to now be assisting the client with the implementation of the chosen systems.


Revenue cycle analysis for a healthcare provider

Our client is one of the few independent, community-based, providers of integrated addiction treatment and primary care services in the United States, serving New Yorkers with substance use disorder who are disproportionately low-income. Without the resources of major healthcare systems, many independent providers had faced challenges with New York State’s Medicaid redesign transition, as they had gone from billing most of their services through a single-payer (the State) to billing around ten different managed care payors. Our client estimated they had lost 5% in revenue during the transition, an amount that was the difference between operating surplus and loss for this non-profit organization. They were also implementing a new electronic health record system. The CEO hired Anoteros to evaluate the end-to-end revenue cycle process and provide recommendations for improvement.

We assembled a team with a mix of expertise in provider billing, payor claims processing, and healthcare technology. To understand all aspects of the revenue cycle we met with staff from finance, IT, and clinical departments as well as the third-party billing vendor, reviewed service and billing data, and assessed the relevant capabilities of both the clinical electronic health record system and the billing system. We took a methodical approach to assess the current process and systems, identify the gaps, and use that analysis to inform recommended actions. Recognizing that “every dollar counts” we did not wait until the final report to share our recommendations, ensuring that leadership was informed immediately when we found a significant issue, so that adjustments could be made in the current billing cycle.

The client did not have the resources of a major provider system, so we placed a lot of importance on ensuring our recommendations were realistic, actionable, and prioritized. Our work provided the client – and their Board – with a comprehensive understanding of the gaps and issues in their current process and enabled them to take a step-by-step approach to address the issues over the following months.


IT strategy for a home health provider

Our client is a home health care provider servicing the New York metro area. The client was seeking assistance with an IT strategy and roadmap, with a primary focus on developing a plan for its highest priority, a cloud-based data warehouse. The organization was growing rapidly via the acquisition of smaller homecare agencies and needed a consolidated view of all its businesses and their underlying performances.

Anoteros assembled a team consisting of a program manager, business analyst, cloud data architect, and an Anoteros partner. Through meetings with key business leaders, IT staff, and other functional experts in the organization, we were able to assess and document the future state IT needs of the organization. Our assessment evaluated all major applications and their pain points and limitations. We developed a roadmap for remediation of these gaps with specific recommendations on solutions and projects for the client to undertake in several key areas including Billing, Accounts Receivable, and Payroll.

We also spent significant time evaluating the client’s data needs by analyzing key source systems, reviewing existing reports and KPIs, and ascertaining the client’s future data needs to support its operations and growth plans. Anoteros developed a plan for an Azure data warehouse solution utilizing various components of Microsoft’s cloud data stack.

Anoteros developed a detailed roadmap with timelines and budgets, providing a blueprint for IT investments required to support the organization’s growth plans. We designed the technical architecture for the new data warehouse and built a dynamic finance model for all Azure-related costs based on the client’s current data needs, but accounting for future growth tied to patient census projections.


Selecting a new HCM (Human Capital Management) solution for a leading non-profit

Our client is a non-profit organization based in New York City. The client was on its third human resources and payroll (HR) system in ten years and was frustrated that the current system was not meeting its needs. There was significant manual effort and calculation involved in running payroll each cycle, and employees and managers found the system hard to use. There were also defects which the vendor had not been able to resolve.

The client approached Anoteros for support in sourcing a replacement system, with a clear goal that the new system must meet the client’s need for both the short and long-term.

Anoteros recommended a more thorough selection process than the client had used for its past system selections. This started with a current state assessment where we shadowed and held workshops with the HR and Finance teams to map their current processes and identify where there were issues, gaps, and opportunities. The assessment identified opportunities for improvement not just in the technology but in policies, process, and roles. Using the insight garnered from the assessment, Anoteros developed a list of 650 business requirements for the new HR system and broader recommendations for policy and process improvements.

Perhaps the most significant finding from the assessment was that the client’s current-basis pay approach was an impediment to fully automating the payroll process. The client’s current system simply wasn’t built for it, and therefore had been configured to “fit a round peg into a square hole”, which explained why the current process required so many manual interventions.

Anoteros conducted a market scan to identify HR systems that could meet the client’s requirements, including a current-basis pay approach, as the client was considering in parallel whether to move to arrears-basis and did not want to force that decision due to a system selection. From the market scan, three vendors were identified and we worked with the client to conduct a thorough Request for Proposal, demo, and selection process. After presenting the options and recommendation to the leadership team, the recommended vendor was approved and we then led the contract negotiations process.

When Anoteros and the HR team presented the preferred vendor recommendation to the client’s leadership team, along with the recommendation to change the pay approach from current-basis to arrears-basis, both recommendations received unanimous approval, with the robust approach giving the leaders confidence that they were making the right decision for the organization.

In the contract negotiations, we realized 28% in savings over the term of the contract and secured substantial protections for the client related to data security and system resiliency.

We are now thrilled to be leading the implementation process for the client.


Implementing a new HCM (Human Capital Management) solution for a leading non-profit

Our client is a non-profit organization based in New York City. Following a robust selection process, the client asked Anoteros to manage the implementation of their new human capital management (HCM) system. In addition to the system change, the client had decided to change its pay cycle from semi-monthly current basis to bi-weekly arrears basis. The client also sought Anoteros’ assistance in rolling out this significant change to its staff alongside the system change.

Anoteros provided the following support to the client throughout the implementation project:

  • Pay cycle change management: We helped the client develop employee communications and a loan program that would assist employees in managing the shift to arrears pay.
  • Project management: We acted as client-side project manager, ensuring the vendor was delivering as expected and that client team members were also fulfilling their responsibilities.
  • Business analysis: We worked alongside the HR team and the vendor as they configured the new HCM and helped to ‘translate’ between business needs and system capabilities.
  • General ledger expertise: We supported the client’s Finance team in working with the vendor to design a custom post-payroll general ledger export.

The transition to the new system was successful, with no payroll errors. The time taken to run payroll is significantly reduced due to increased automation and elimination of reconciliation ‘re-work’ that is inherent to current basis pay cycles. Additional interfaces with benefits carriers have reduced manual data input and transfer. Supervisors report a much easier timecard approval process, and HR has automated several previously manual processes. In addition, the client’s Finance team has eliminated all manual manipulation that they previously had to do on the HCM general ledger export.


Reimplementing a Finance and Accounting System For a Large Non-Profit

The client is a large NYC-based nonprofit that is primarily grant funded. The organization had been leveraging a simplified version of Sage Intacct that was implemented and supported by a boutique accounting firm for years. The client was often challenged with effectively keeping up with its operational accounting needs and providing timely and detailed financials to key stakeholders and funders. Though the experience with the system had not been overly positive, the Finance leadership team was willing to consider staying with a reconfigured version of the system.

Anoteros provided the client support through its pivotal decision making process, bringing in a consultant with a decade of nonprofit and Sage Intacct experience to conduct an initial assessment. The outcome of the evaluation was a decision to leverage a new Sage Intacct implementation partner with support from Anoteros to guide the client through the re-implementation of the solution.

Anoteros provided specialized experience in the non-profit sector, facilitating in-depth and ultimately crucial planning sessions to determine a blueprint for the reconfigured solution. Coupled with the Sage Intacct expertise of the implementation partner, all three parties were able to deliver an effective and efficient solution to meet the client’s requirements.

After a successful re-implementation, the client is now configured on a more robust, easy-to-use, and deliberate configuration of Sage Intacct that has allowed it to reclaim crucial time previously lost due to the shortcomings of the legacy system. Since go-live, the client has taken on two additional implementations with the Anoteros team, SAP Concur for expense management, and DataBlend for its integration needs. The client continues to improve and invest in its systems to optimize its finance and accounting functions.

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